Painful Big Toe Not Always Worst Sign of Gout

Pain in the big toe is one of the most common symptoms of gout, but researchers at the Mayo Clinic say patients who experience the worst flare-ups are those whose gout first appeared in other joints, such as the knee and elbow.

The researchers followed 46 gout patients for over a dozen years. Most of the patients were male, and the mean age at which gout first appeared was 66. The patients at highest risk for flare-ups of gout pain had gout originate in another joint, says co-author Eric Matteson, MD, rheumatology chair at Mayo Clinic in Rochester, Minn.

More than 8 million Americans suffer from gout, an inflammatory arthritis of the joints that causes excruciating pain and swelling. Their bodies produce too much uric acid or has problems flushing it out, causing urate crystals to build up in the joints. One of the most common symptoms of gout is waking up at night feeling like your big toe is on fire.

Gout attacks can also include swelling, redness, intense pain, and tenderness that can radiate to the ankle, foot, and knees. Gout attacks can last from several days to weeks, and each subsequent attack becomes more painful.

“Because patients often think that a gout flare-up means their medications are not working, they may stop medications like allopurinol. It is especially important for these patients to continue taking gout medication to prevent flare-ups,” Dr. Matteson says.

Mayo researchers will also report on a study that found African-American lupus patients with certain autoantibodies have higher levels of interferon, a protein involved in inflammation. The discovery may help explain why lupus tends to be worse in blacks than in whites.

“We know that African-American patients have worse lupus than patients who are Caucasian. We haven’t really understood exactly why that is,” says Matteson. “This increased expression of interferon may be one of the keys why African-American patients have worse lupus.”

Systemic Lupus Erythematosus, also known as SLE, is a chronic inflammatory disease caused by an immune disorder. One and a half million Americans suffer from lupus and at least five million people worldwide.

Lupus can cause extreme fatigue, painful and swollen joints, unexplained fever, and skin rash. It also can lead to kidney failure, heart and lung inflammation, central nervous system disorders and inflammation of the blood vessels.